Use of a modified delphi process for establishing occupational exposure limits in support of health surveillance for space travelers

On-orbit exposures can come from numerous factors related to the space environment as evidenced by almost 50 years of environmental samples collected for water analysis, air analysis, radiation analysis, and physiologic parameters. For astronauts and spaceflight participants the occupational exposures can be very different from those experienced by workers performing similar tasks in workplaces on Earth, because the duration of the exposure could be continuous for very long orbital, and eventually interplanetary, missions. The establishment of long-term exposure standards is vital to controlling the quality of the spacecraft environment over long periods. NASA often needs to update and revise its prior exposure standards (Spacecrafts Maximum Allowable Concentrations (SMACs)). Traditional standards-setting processes are often lengthy, so a more rapid method to review and establish standards would be a substantial advancement in this area. This project investigates use of the Delphi method for this purpose. ^ In order to achieve the objectives of this study a modified Delphi methodology was tested in three trials executed by doctoral students and a panel of experts in disciplines related to occupational safety and health. During each test/trial modifications were made to the methodology. Prior to submission of the Delphi Questionnaire to the panel of experts a pilot study/trial was conducted using five doctoral students with the goals of testing and adjusting the Delphi questionnaire to improve comprehension, work out any procedural issues and evaluate the effectiveness of the questionnaire in drawing the desired responses. The remainder of the study consisted of two trials of the Modified Delphi process using 6 chemicals that currently have the potential of causing occupational exposures to NASA astronauts or spaceflight participants. To assist in setting Occupational Exposure Limits (OEL), the expert panel was established consisting of experts from academia, government and industry. Evidence was collected and used to create close-ended questionnaires which were submitted to the Delphi panel of experts for the establishment of OEL values for three chemicals from the list of six originally selected (trial 1). Once the first Delphi trial was completed, adjustments were made to the Delphi questionnaires and the process above was repeated with the remaining 3 chemicals (trial 2). ^ Results indicate that experience in occupational safety and health and with OEL methodologies can have a positive effect in minimizing the time experts take in completing this process. Based on the results of the questionnaires and comparison of the results with the SMAC already established by NASA, we conclude that use of the Delphi methodology is appropriate for use in the decision-making process for the selection of OELs.^

Critical success factors of project management for Brunei construction projects : improving project performance

The problem of delays in the construction industry is a global phenomenon and the construction industry in Brunei Darussalam is no exception. The goal of all parties involved in construction projects – owners, contractors, engineers and consultants in either the public or private sector is to successfully complete the project on schedule, within planned budget, with the highest quality and in the safest manner. Construction projects are frequently influenced by either success factors that help project parties reach their goal as planned, or delay factors that stifle or postpone project completion. The purpose of this research is to identify success and delay factors which can help project parties reach their intended goals with greater efficiency. This research extracted seven of the most important success factors according to the literature and seven of the most important delay factors identified by project parties, and then examined correlations between them to determine which were the most influential in preventing project delays. This research uses a comprehensive literature review to design and conduct a survey to investigate success and delay factors and then obtain a consensus of expert opinion using the Delphi methodology to rank the most needed critical success factors for Brunei construction projects. A specific survey was distributed to owners, contractors and engineers to examine the most critical delay factors. A general survey was distributed to examine the correlation between the identified delay factors and the seven most important critical success factors selected. A consensus of expert opinion using the Delphi methodology was used to rank the most needed critical success factors for Brunei building construction. Data was collected and evaluated by statistical methods to identify the most significant causes of delay and to measure the strength and direction of the relationship between critical success factors and delay factors in order to examine project parties’ evaluation of projects’ critical success and delay factors, and to evaluate the influence of critical success factors on critical delay factors. A relative importance index has been used to determine the relative importance of the various causes of delays. A one and two-way analysis of variance (ANOVA) has been used to examine how the group or groups evaluated the influence of the critical success factors in avoiding or preventing each of the delay factors, and which success factors were perceived as most influential in avoiding or preventing critical delay factors. Finally the Delphi method, using consensus from an expert panel, was employed to identify the seven most critical success factors used to avoid the delay factors, and thereby improve project performance.

Like? Advertising practitioners views of social media as an advertising research tool

Given that both academics and marketers are dissatisfied with the current state of advertising research (Kerr and Schultz, 2010; Neff, 2011), the objective of this exploratory paper is to determine the position of world-leading advertising professionals on the use of social media to test, track and evaluate campaigns. Using Delphi methodology, an international panel of Cannes Gold Lion winners acknowledged that social media research has both strengths and weaknesses, the same as any research. Its strengths are its intimacy and spontaneity, bringing the brand and consumer closer. The real risk is the loss of control in this research environment.

Defining food literacy and its components

Food literacy has emerged as a term to describe the everyday practicalities associated with healthy eating. The term is increasingly used in policy, practice, research and by the public; however, there is no shared understanding of its meaning. The purpose of this research was to develop a definition of food literacy which was informed by the identification of its components. This was considered from two perspectives: that of food experts which aimed to reflect the intention of existing policy and investment, and that of individuals, who could be considered experts in the everyday practicalities of food provisioning and consumption. Given that food literacy is likely to be highly contextual, this second study focused on disadvantaged young people living in an urban area who were responsible for feeding themselves. The Expert Study used a Delphi methodology (round one n = 43). The Young People’s Study used semi-structured, life-course interviews (n = 37). Constructivist Grounded Theory was used to analyse results. This included constant comparison of data within and between studies. From this, eleven components of food literacy were identified which fell into the domains of: planning and management; selection; preparation; and eating. These were used to develop a definition for the term “food literacy”.

Enhancing paramedics procedural skills using a cadaveric model

Background Paramedic education has evolved in recent times from vocational post-employment to tertiary pre-employment supplemented by clinical placement. Simulation is advocated as a means of transferring learned skills to clinical practice. Sole reliance of simulation learning using mannequin-based models may not be sufficient to prepare students for variance in human anatomy. In 2012, we trialled the use of fresh frozen human cadavers to supplement undergraduate paramedic procedural skill training. The purpose of this study is to evaluate whether cadaveric training is an effective adjunct to mannequin simulation and clinical placement. Methods A multi-method approach was adopted. The first step involved a Delphi methodology to formulate and validate the evaluation instrument. The instrument comprised of knowledge-based MCQs, Likert for self-evaluation of procedural skills and behaviours, and open answer. The second step involved a pre-post evaluation of the 2013 cadaveric training. Results One hundred and fourteen students attended the workshop and 96 evaluations were included in the analysis, representing a return rate of 84%. There was statistically significant improved anatomical knowledge after the workshop. Students' self-rated confidence in performing procedural skills on real patients improved significantly after the workshop: inserting laryngeal mask (MD 0.667), oropharyngeal (MD 0.198) and nasopharyngeal (MD 0.600) airways, performing Bag-Valve-Mask (MD 0.379), double (MD 0.344) and triple (MD 0.326,) airway manoeuvre, doing 12-lead electrocardiography (MD 0.729), using McGrath(R) laryngoscope (MD 0.726), using McGrath(R) forceps to remove foreign body (MD 0.632), attempting thoracocentesis (MD 1.240), and putting on a traction splint (MD 0.865). The students commented that the workshop provided context to their theoretical knowledge and that they gained an appreciation of the differences in normal tissue variation. Following engagement in/ completion of the workshop, students were more aware of their own clinical and non-clinical competencies. Conclusions The paramedic profession has evolved beyond patient transport with minimal intervention to providing comprehensive both emergency and non-emergency medical care. With limited availability of clinical placements for undergraduate paramedic training, there is an increasing demand on universities to provide suitable alternatives. Our findings suggested that cadaveric training using fresh frozen cadavers provides an effective adjunct to simulated learning and clinical placements.

Somatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children: CHEST Guideline and Expert Panel Report

BACKGROUND: We conducted a systematic review on the management of psychogenic cough, habit cough, and tic cough to update the recommendations and suggestions of the 2006 guideline on this topic.

METHODS: We followed the American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework. The Expert Cough Panel based their recommendations on data from the systematic review, patients' values and preferences, and the clinical context. Final grading was reached by consensus according to Delphi methodology.

RESULTS: The results of the systematic review revealed only low-quality evidence to support how to define or diagnose psychogenic or habit cough with no validated diagnostic criteria. With respect to treatment, low-quality evidence allowed the committee to only suggest therapy for children believed to have psychogenic cough. Such therapy might consist of nonpharmacologic trials of hypnosis or suggestion therapy, or combinations of reassurance, counseling, and referral to a psychologist, psychotherapy, and appropriate psychotropic medications. Based on multiple resources and contemporary psychologic, psychiatric, and neurologic criteria (Diagnostic and Statistical Manual of Mental Disorders, 5th edition and tic disorder guidelines), the committee suggests that the terms psychogenic and habit cough are out of date and inaccurate.

CONCLUSIONS: Compared with the 2006 CHEST Cough Guidelines, the major change in suggestions is that the terms psychogenic and habit cough be abandoned in favor of somatic cough syndrome and tic cough, respectively, even though the evidence to do so at this time is of low quality.

Percepción de la erosión agraria

Esta investigación analiza mediante la metodología Delphi varios indicadores de calidad del suelo del olivar español, en particular, la textura, la fertilidad, el color, la profundidad, la compactación, la aireación, la materia orgánica y la infiltración del agua. El objetivo consiste en describir la percepción de los olivicultores acerca del grado de erosión en la zona de estudio, teniendo en cuenta su propia autovaloración referida a su nivel de adopción de innovaciones y a su actitud frente al riesgo de aplicar nuevas tecnologías. El panel de expertos seleccionados está formado por 63 olivicultores de la cuenca granadina del Alto Genil en el año 2005; esta zona se caracteriza por el cultivo del olivar en ladera y sus consiguientes niveles de erosión medio-altos, por lo que la actividad agraria se encuentra fuertemente condicionada por el grado de implementación de prácticas de conservación del suelo, específicamente por el laboreo según curvas de nivel, el no laboreo con herbicidas y el mantenimiento de restos de poda sobre la capa edáfica (según una encuesta preliminar del año 2004), así como por su promoción a través de la reciente legislación europea en materia agroambiental.

Proposta de uma matriz de decisão em energia hidrelétrica com o uso do método multicritério, para formulação de políticas públicas no estado do Paraná

Brazil is internationally acknowledged for its renewable sources, most notably, hydroelectric power plant projects which correspond to 65% of electricity production supply to the National Interconnected System. The main question behind this research is: what are the weights and the relative importance of the variables which have influence on the decision making process for the expansion of hydroelectric generation projects in Parana? The main objective is to propose a multi-criteria decision procedure, in association with water sources options that take into consideration the weight and relative importance of the alternatives having influence on the decision by enterprises in the generation of electricity in the state of Paraná. As far as the approach to the problem is concerned, this research can be classified as having mixed methodologies, applying Content Analysis, Delphi technique and the Analytic Hierarchy Process. Following Delphi methodology, a group of 21 was selected for data collection, all of those linked to Paranaense hydroelectricity market. And the main result was the construction of a decision tree in which it was possible to identify the importance and relative weight of the elements associated with the four dimensions of energy. In environmental dimension, the highest relative weight was placed on the loading capacity of Parana system; the economic dimension, the amortization of investment; in social dimension, the generation of direct work places and in institutional dimension, the availability of suitable sources of financing. Policy makers and business managers make their decisions based on specific criteria related to the organization segment, market information, economic and political behavior among other indicators that guide them in dealing with the typical tradeoffs of projects in hydropower area. The results obtained in the decision tree show that the economic bias is still the main factor in making investment decisions. However, environmental impacts on the State loading capacity, income generation, providing opportunities for direct as well as indirect jobs. And at an institutional level, the absence of funding sources show that the perception of experts is focused on other issues beyond the logic behind development per se. The order of priority of variables in this study indicates that in the current environment of uncertainty in the Brazilian economy as many variables must be analyzed and compared in order to optimize the scarce resources available to expand local development in relation to Paranaense water matrix.

Measuring complexity for building projects : a Delphi study

Purpose---The aim of this study is to identify complexity measures for building projects in the People’s Republic of China (PRC). Design/Methodology/Approach---A three-round of Delphi questionnaire survey was conducted to identify the key parameters that measure the degree of project complexity. A complexity index (CI) was developed based on the identified measures and their relative importance. Findings---Six key measures of project complexity have been identified, which include, namely (1) building structure & function; (2) construction method; (3) the urgency of the project schedule; (4) project size/scale; (5) geological condition; and (6) neighboring environment. Practical implications---These complexity measures help stakeholders assess degrees of project complexity and better manage the potential risks that might be induced to different levels of project complexity. Originality/Value---The findings provide insightful perspectives to define and understand project complexity. For stakeholders, understanding and addressing the complexity help to improve project planning and implementation.

Which cultural values matter to business process management? Results from a global Delphi study

Purpose – Business process management (BPM) requires a holistic perspective that includes managing the culture of an organization to achieve objectives of efficient and effective business processes. Still, the specifics of a BPM-supportive organizational culture have not been examined so far. Thus, the purpose of this paper is to identify the characteristics of a cultural setting supportive of BPM objectives. Design/methodology/approach – The paper examines the constituent values of a BPM-supportive cultural setting through a global Delphi study with BPM experts from academia and practice and explore these values in a cultural value framework. Findings – The paper empirically identifies and defines four key cultural values supporting BPM, viz., customer orientation, excellence, responsibility, and teamwork. The paper discusses the relationships between these values and identifies a particular challenge in managing these seemingly competing values. Research limitations/implications – The identification and definition of these values represents a first step towards the operationalization (and empirical analysis) of what has been identified as the concept of BPM culture, i.e. a culture supportive of achieving BPM objectives. Practical implications – Identifying these cultural values provides the basis for developing an instrument that can measure how far an existing cultural context is supportive of BPM. This, in turn, is fundamental for identifying measures towards achieving a BPM culture as a necessary, yet not sufficient means to obtain BPM success. Originality/value – The paper examines which cultural values create an environment receptive for BPM and, thus, specifies the important theoretical construct BPM culture. In addition, the paper raises awareness for realizing these values in a BPM context.

A methodology to develop an urban transport disadvantage framework : the case of Brisbane, Australia

Most individuals travel in order to participate in a network of activities which are important for attaining a good standard of living. Because such activities are commonly widely dispersed and not located locally, regular access to a vehicle is important to avoid exclusion. However, planning transport system provisions that can engage members of society in an acceptable degree of activity participation remains a great challenge. The main challenges in most cities of the world are due to significant population growth and rapid urbanisation which produces increased demand for transport. Keeping pace with these challenges in most urban areas is difficult due to the widening gap between supply and demand for transport systems which places the urban population at a transport disadvantage. The key element in mitigating the issue of urban transport disadvantage is to accurately identify the urban transport disadvantaged. Although wide-ranging variables and multi-dimensional methods have been used to identify this group, variables are commonly selected using ad-hoc techniques and unsound methods. This poses questions of whether the current variables used are accurately linked with urban transport disadvantage, and the effectiveness of the current policies. To fill these gaps, the research conducted for this thesis develops an operational urban transport disadvantage framework (UTDAF) based on key statistical urban transport disadvantage variables to accurately identify the urban transport disadvantaged. The thesis develops a methodology based on qualitative and quantitative statistical approaches to develop an urban transport disadvantage framework designed to accurately identify urban transport disadvantage. The reliability and the applicability of the methodology developed is the prime concern rather than the accuracy of the estimations. Relevant concepts that impact on urban transport disadvantage identification and measurement and a wide range of urban transport disadvantage variables were identified through a review of the existing literature. Based on the reviews, a conceptual urban transport disadvantage framework was developed based on the causal theory. Variables identified during the literature review were selected and consolidated based on the recommendations of international and local experts during the Delphi study. Following the literature review, the conceptual urban transport disadvantage framework was statistically assessed to identify key variables. Using the statistical outputs, the key variables were weighted and aggregated to form the UTDAF. Before the variable's weights were finalised, they were adjusted based on results of correlation analysis between elements forming the framework to improve the framework's accuracy. The UTDAF was then applied to three contextual conditions to determine the framework's effectiveness in identifying urban transport disadvantage. The development of the framework is likely to be a robust application measure for policy makers to justify infrastructure investments and to generate awareness about the issue of urban transport disadvantage.

Methodology for developing competency standards for dietitians in Australia

Competency standards document the knowledge, skills, and attitudes required for competent performance. This study develops competency standards for dietitians in order to substantiate an approach to competency standard development. Focus groups explored the current and emerging purpose, role, and function of the profession, which were used to draft competency standards. Consensus was then sought using two rounds of a Delphi survey. Seven focus groups were conducted with 28 participants (15 employers/practitioners, 5 academics, 8 new graduates). Eighty-two of 110 invited experts participated in round one and 67 experts completed round two. Four major functions of dietitians were identified: being a professional, influencing the health of individuals, groups, communities, and populations through evidence-based nutrition practice, and working collaboratively in teams. Overall there was a high level of consensus on the standards: 93% achieved agreement by participants in round one and all revised standards achieved consensus on round 2. The methodology provides a framework for other professions wishing to embark on competency standard review or development.

A Delphi Process to Optimize Quality and Performance of Drug Evaluation in Neonates

Background: Neonatal trials remain difficult to conduct for several reasons: in particular the need for study sites to have an existing infrastructure in place, with trained investigators and validated quality procedures to ensure good clinical, laboratory practices and a respect for high ethical standards. The objective of this work was to identify the major criteria considered necessary for selecting neonatal intensive care units that are able to perform drug evaluations competently. Methodology and Main Findings: This Delphi process was conducted with an international multidisciplinary panel of 25 experts from 13 countries, selected to be part of two committees (a scientific committee and an expert committee), in order to validate criteria required to perform drug evaluation in neonates. Eighty six items were initially selected and classified under 7 headings: "NICUs description - Level of care'' (21), "Ability to perform drug trials: NICU organization and processes (15), "Research Experience'' (12), "Scientific competencies and area of expertise'' (8), "Quality Management'' (16), "Training and educational capacity'' (8) and "Public involvement'' (6). Sixty-one items were retained and headings were rearranged after the first round, 34 were selected after the second round. A third round was required to validate 13 additional items. The final set includes 47 items divided under 5 headings. Conclusion: A set of 47 relevant criteria will help to NICUs that want to implement, conduct or participate in drug trials within a neonatal network identify important issues to be aware of. Summary Points: 1) Neonatal trials remain difficult to conduct for several reasons: in particular the need for study sites to have an existing infrastructure in place, with trained investigators and validated quality procedures to ensure good clinical, laboratory practices and a respect for high ethical standards. 2) The present Delphi study was conducted with an international multidisciplinary panel of 25 experts from 13 countries and aims to identify the major criteria considered necessary for selecting neonatal intensive care units (NICUs) that are able to perform drug evaluations competently. 3) Of the 86 items initially selected and classified under 7 headings - "NICUs description - Level of care'' (21), "Ability to perform drug trials: NICU organization and processes (15), "Research Experience'' (12), "Scientific competencies and area of expertise'' (8), "Quality Management'' (16), "Training and educational capacity'' (8) and "Public involvement'' (6) - 47 items were selected following a three rounds Delphi process. 4) The present consensus will help NICUs to implement, conduct or participate in drug trials within a neonatal network.

Content validation for level of use of feature rich systems: a Delphi study of electronic medical records systems

Introduction. Feature usage is a pre-requisite to realising the benefits of investments in feature rich systems. We propose that conceptualising the dependent variable 'system use' as 'level of use' and specifying it as a formative construct has greater value for measuring the post-adoption use of feature rich systems. We then validate the content of the construct as a first step in developing a research instrument to measure it. The context of our study is the post-adoption use of electronic medical records (EMR) by primary care physicians. Method. Initially, a literature review of the empirical context defines the scope based on prior studies. Having identified core features from the literature, they are further refined with the help of experts in a consensus seeking process that follows the Delphi technique. Results.The methodology was successfully applied to EMRs, which were selected as an example of feature rich systems. A review of EMR usage and regulatory standards provided the feature input for the first round of the Delphi process. A panel of experts then reached consensus after four rounds, identifying ten task-based features that would be indicators of level of use. Conclusions. To study why some users deploy more advanced features than others, theories of post-adoption require a rich formative dependent variable that measures level of use. We have demonstrated that a context sensitive literature review followed by refinement through a consensus seeking process is a suitable methodology to validate the content of this dependent variable. This is the first step of instrument development prior to statistical confirmation with a larger sample.